Nudgefail: The Case of Organ Donation

Behavioral economics is cool science with numerous applications. The concept of nudges, for example requiring newly hired workers to sign a form to stop automatic retirement contributions rather than having to sign a form to start them, is certainly useful in many contexts. But as I write in Washington Post’s Wonkblog, it can’t solve some problems, including the shortage of organ donations, which leaves over 120,000 Americans on the waiting list:

One commonly proposed solution to the organ shortage derives from behavioral economic â€œnudgeâ€ principles. Rather than requiring Americans to complete paperwork in order to opt-in to donation at death, the country could shift to the European model of presuming that donation at death was acceptable. But Tom Mone, chief executive of OneLegacy, the nationâ€™s largest organ and tissue recovery organization, points out that â€œThe recovery rate for deceased donors in the United States is actually better than that of European nations with presumed consent laws. The United States rigorously follows individual donor registrations whereas presumed consent countries actually defer to family objections.â€

What this means on the ground, as Tom explained to me and our audience at a recent Stanford Health Policy Forum, is that when European health professionals show up to harvest organs from a newly dead individual, that person’s family often says “no way”, nudges be damned. The state could legally take the person’s organs by force of course, but unsurprisingly it does not. In contrast, in the US opt-in model, both families and the state respect the deceased donor’s wishes because they know they were the result of a proactive decision rather than a bureaucratically-designed nudge. More simply, an active choice has legitimacy that a nudged choice does not